HOW  CERTIFIED  NURSING  HOMES

ARE  SUPPOSED  TO  OPERATE


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     To fully understand what constitutes a nursing home and how they work it is best to go to the laws and regulations that control their operations and payment for services.  All states have licensing and operating laws for nursing homes.  In addition, the majority of residential long term medical care facilities in the United States are certified by Medicare and Medicaid to provide services to a well defined population of those requiring short term rehabilitation and long term medical care.


        The laws that establish what a Medicare/Medicaid certified nursing home is to be and what they must do, serve as the operational standards of those nursing homes.  The exception are those nursing homes who do not accept Medicare/Medicaid payment and operate only under their state laws and regulations.


        The definition of a certified skilled nursing facility comes from describing what the facility does as a care provider, the range of services provided, and how it goes about providing those services.  Those defining requirements for the operation of certified Medicare/Medicaid nursing homes are established in the following federal act. Only parts (a-d) of the act are presented here.  The remainder, parts (e-j), is not presented because it covers procedural matters for applying and enforcing the act.


 


PAGE CONTENTS


        1. SKILLED NURSING FACILITY DEFINED


        2.  PROVISION OF SERVICES


    A. Requirements relating to provision of services

    B. Scope of services and activities under plan of care

    C. Residents’ assessment

    D. Certification (of assessment)

    E. Frequency (of assessment)

    F. Use (of assessment)

    G. Coordination (with other screening)

    H. Provision of services and activities

    I. Qualified persons providing services

    J. Required nursing care

    K. Required training of nurse aides

    L. (Nurse aide) Re-training required

    M. Regular (nurse aide) in-service education

    N. Nurse aide defined

    O. Licensed health professional defined

    P. Physician supervision (of care) and clinical records

    Q. Required social services

    R. (Posted) Information on nurse staffing


        3. RESIDENTS’ RIGHTS

  

    A. Requirements relating to residents’ rights

    B. Notice of rights and services

    C. Rights of incompetent residents

    D. Use of psychopharmacologic drugs

    E. Information respecting advanced directives

    F. Transfer and discharge rights

    G. Pre-transfer and pre-discharge notice

    H. Timing of notice (of transfer or discharge)

    I. Items included in notice (of transfer or discharge)

    J. Orientation (for transfer or discharge)

    K. Access and visitation rights

    L. Equal access to quality care

    M. Admissions policy

    N. Construction

    O. Protection of resident funds

    P. Management of personal funds

    Q. Assurance of financial security

    R. Limitations on charges to personal funds


        4. ADMINISTRATION AND OTHER MATTERS

  

    A. Administration

    B. Licensing and life safety code

    C. Sanitary and infection control and physical environment

    D. Miscellaneous


        5. STATE LICENSING LAWS & OPERATING

            REGULATIONS




  Requirements for, and assuring quality of care in skilled nursing facilities. Sec. 1819. (42 U.S.C.1395i-3)          www.ssa.gov/OP_Home/ssact/title18/1819.htm


   1. SKILLED NURSING FACILITY DEFINED


    In this title, the term “skilled nursing facility” means an institution or a distinct part of an institution which -

  1. (1)is primarily engaged in providing to residents, skilled nursing care and related services for those who require medical or nursing care, or rehabilitation services for the rehabilitation of injured, disabled, or sick persons, and not primarily for the care and treatment of mental diseases;


  1. (2) has in effect a transfer agreement with one or more hospitals; and


  1. (3)meets the requirements for provision of services, resident rights, and administration and related matters for a skilled nursing facility described in subsequent subsections of this act.



    2. PROVISION OF SERVICES


A. Requirements relating to provision of services.

   Quality of life - In general a skilled nursing facility must care for its residents in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident.


    Quality assessment & assurance - A skilled nursing facility must maintain a quality assessment and assurance committee, consisting of the director of nursing services, a physician designated by the facility, and at least 3 other members of the facility's staff which-

  1. (1)meets at least quarterly to identify issues to which quality assessment and assurance activities are necessary, and

  2. (2)develops and implements appropriate plans of action to correct identified quality deficiencies.


B. Scope of services and activities under plan of care.

    A skilled nursing facility must provide services to attain or maintain the highest practicable physical, mental, and psychosocial well being of each resident, in accordance with a written plan of care which -

  1. (1)describes the medical, nursing, and psychosocial needs of the resident and how such needs will be met;

  2. (2)is initially prepared, with the participation, to the extent practicable, of the resident or the resident's family or legal representative, by a team which includes the resident's attending physician and a registered professional nurse with responsibility for the resident; and

  3. (3)is periodically reviewed and revised by such team after each comprehensive assessment.


C. Residents' assessment.

   Requirement - A skilled nursing facility must conduct a comprehensive, accurate, standardized, reproducible assessment of each resident's functional capacity, which -

  1. (1)describes the resident's capability to perform daily life functions and significant impairments in functional capacity;

  2. (2)is based on a uniform minimum data set (MDS);

  3. (3)uses an instrument which is specified by the State; and

  4. (4)includes the identification of medical problems.


D. Certification

    In general.- Each such assessment must be conducted or coordinated with the appropriate participation of health professionals by a registered professional nurse who signs and certifies the completion of the assessment. Each individual who completes a portion of such an assessment shall sign and certify as to the accuracy of that portion of the assessment.


E. Frequency

    In general.- Subject to the timeframes prescribed by the Secretary, such an assessment must be conducted -

  1. (1)promptly upon, but no later than 14 days after the date of admission for each individual admitted;

  2. (2)promptly after a significant change in the resident's physical or mental condition; and

  3. (3)in no case less often than once every 12 months.


   Resident review.- The skilled nursing facility must examine each resident no less frequently than once every 3 months and, as appropriate, revise the resident's assessment to assure the continuing accuracy of the assessment.


F. Use

    The results of such an assessment shall be used in developing, reviewing, and revising the resident's plan of care.


G. Coordination

    Such assessments shall be coordinated with any State required pre-admission screening program to the maximum extent practicable to avoid duplicative testing and effort.


H. Provision of services and activities

    In general.- To the extent needed to fulfill all plans of care, a skilled nursing facility must provide, directly or under arrangements with others, for the provision of -

  1. (1)nursing services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;

  2. (2)medically related social services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident;

  3. (3)pharmaceutical services including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all drugs and biologicals to meet the needs of each resident;

  4. (4)dietary services that assure that the meals meet the daily nutritional and special dietary needs of each resident;

  5. (5)an on-going program, directed by a qualified professional, of activities designed to meet the interests and the physical, mental, and psychosocial well-being of each resident.

  6. (6)routine and emergency dental services to meet the needs of each resident; and

  7. (7)treatment and services required by mentally ill and mentally retarded residents not otherwise provided or arranged for or required to be provided or arranged for by the State.


    The services provided or arranged by the facility must meet professional standards of quality.


    Nothing in (6) above shall be construed as requiring a facility to provide or arrange for dental services described in that clause without additional charge.


I. Qualified persons providing services.

    Services described in clauses (1) through (6) above must be provided by qualified persons in accordance with each resident's written plan of care.


J. Required nursing care.

   In general. - Except as provided in clause (2) below, a skilled nursing facility must provide 24-hour licensed nursing service which is sufficient to meet nursing needs of its residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, 7 days a week.


   Exception. - To the extent that the requirement above may be considered to require that a skilled nursing facility engage the services of a registered professional nurse for more than 40 hours a week, the Secretary is authorized to waive such requirement if the Secretary finds that -

  1. (1)the facility is located in a rural area and the supply of skilled nursing facility services in such area is not sufficient to meet the needs of individuals residing therein,

  2. (2)the facility has one full-time registered professional nurse who is regularly on duty at such facility 40 hours a week,

  3. (3)the facility either has only patients whose physicians have indicated through physicians' orders or admission notes that each of those patients do not require the services of a registered nurse or a physician for a 48-hour period, or has made arrangements for a registered professional nurse or a physician to spend such time at such facility as may be indicated as necessary by the physician to provide necessary skilled nursing services on days when the regular full-time registered professional nurse is not on duty,

  4. (4)the Secretary provides notice of the waiver to the State long-term care ombudsman and the protection and advocacy system in the State for the mentally ill and the mentally retarded, and

  5. (5)the facility that is granted such a waiver notifies residents of the facility or, where appropriate, the guardians or legal representatives of such residents and members of their immediate families of the waiver.

    A waiver under this subparagraph shall be subject to annual renewal.


K. Required training of nurse aides.

   In general. - Except as provided in the nursing service exception above, a skilled nursing facility must not use, on a full-time basis, any individual as a nurse aide in the facility for more than 4 months unless the individual -

  1. (1)has completed a training and competency evaluation program, or a competency evaluation program, approved by the State and is competent to provide nursing or nursing- related services.

  2. (2)A skilled nursing facility must not use on a temporary, per diem, leased, or on any basis other than as a permanent employee any individual as a nurse aide in the facility unless the individual meets the requirements described in clause (1) above.


    Offering competency evaluation programs for current employees. - A skilled nursing facility must provide, for individuals used as a nurse aide by the facility, a competency evaluation program approved by the State.


    Competency. - The skilled nursing facility must not permit an individual, other than in a training and competency evaluation program approved by the State, to serve as a nurse aide or provide services of a type for which the individual has not demonstrated competency and must not use such an individual as a nurse aide unless the facility has inquired of any State registry that the facility believes will include information concerning the individual.


L. Re-training required.

    For the purposes of required training, if, since an individual's most recent completion of a training and competency evaluation program, there has been a period of 24 consecutive months during which the individual performed no nursing or nursing-related services for monetary compensation, such individual shall complete a new training and competency evaluation program or a new competency evaluation program.


M. Regular in-service education.

    The skilled nursing facility must provide regular performance review and regular in-service education that assures individuals used as nurse aides are competent to perform services as nurse aides, including training for individuals providing nursing and nursing-related services to residents with cognitive impairments.


N. Nurse aide defined.

    In this paragraph, the term “nurse aide” means any individual providing nursing or nursing- related services to residents in a skilled nursing facility, but does not include an individual -

  1. (1)who is a licensed health professional as defined in paragraph O. below or a registered dietician, or

  2. (2)who volunteers to provide such services without monetary compensation.


O. Licensed health professional defined.

    In this paragraph, the term “licensed health professional” means a physician, physician assistant, nurse practitioner, physical, speech, or occupational therapist, physical or occupational therapy assistant, registered professional nurse, licensed practical nurse, or licensed certified social worker, registered respiratory therapist, or certified respiratory therapy technician.


P. Physician supervision and clinical records.

    A skilled nursing facility must -

  1. (1)require that the medical care of every resident be provided under the supervision of a physician;

  2. (2)provide for having a physician available to furnish necessary medical care in case of emergency; and

  3. (3)maintain clinical records on all residents, which records include the plans of care and the residents' assessments.


Q. Required social services.

    In the case of a skilled nursing facility with more than 120 beds, the facility must have at least one social worker with at least a bachelor's degree in social work or similar professional qualifications employed full-time to provide or assure the provision of social services.


R. Information on nurse staffing.

    In general. - A skilled nursing facility shall post daily for each shift the current number of licensed and unlicensed nursing staff directly responsible for resident care in the facility. The information shall be displayed in a uniform manner and in a clearly visible place.


    Publication of data. - A skilled nursing facility shall, upon request, make available to the public the nursing staff data described above.


    3. RESIDENTS’ RIGHTS


A. Requirements relating to residents' rights.

    Specified Rights - A skilled nursing facility must protect and promote the rights of each resident, including each of the following rights:


   Free choice. - The right to choose a personal attending physician, to be fully informed in advance about care and treatment; to be fully informed in advance of any changes in care or treatment that may affect the resident's well-being; and, except with respect to a resident adjudged incompetent, to participate in planning care and treatment or changes in care and treatment.


   Free from restraints. - The right to be free from physical or mental abuse, corporal punishment, involuntary seclusion, and any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident's medical symptoms. Restraints may only be imposed -

  1. (1)to ensure the physical safety of the resident or other residents, and

  2. (2)only upon the written order of a physician that specifies the duration and circumstances under which the restraints are to be used, except in emergency circumstances specified by the Secretary, until such an order could reasonably be obtained.


  Privacy. -The right to privacy with regard to accommodations, medical treatment, written and telephonic communications, visits, and meetings of family and of resident groups.


    Confidentiality - The right to confidentiality of personal and clinical records and to access current clinical records of the resident upon request by the resident or the resident's legal representative within 24 hours, excluding hours occurring during a weekend or holiday, after making such a request.


    Accommodation of needs. - The right to -

  1. (1)reside and receive services with reasonable accommodation of individual needs and preferences, except where the health or safety of the individual or other residents would be endangered, and

  2. (2)receive notice before the room or roommate of the resident in the facility is changed.


    Grievances. - The right to voice grievances with respect to treatment or care that is furnished or fails to be furnished, without discrimination or reprisal for voicing the grievances and the right to prompt efforts by the facility to resolve grievances the resident may have, including those with respect to the behavior of other residents.


    Participation in resident and family groups. - The right of the resident to organize and participate in resident groups in the facility and the right of the resident's family to meet in the facility with the families of other residents in the facility.


    Participation in other activities. - The right of the resident to participate in social, religious, and community activities that do not interfere with the rights of other residents in the facility.


    Examination of survey results. - The right to examine, upon reasonable request, the results of the most recent survey of the facility conducted by the Secretary or a State with respect to the facility and any plan of correction in effect with respect to the facility.


   Refusal of certain transfers. - The right to refuse a transfer to another room within the facility, if a purpose of the transfer is to relocate the resident from a portion of the facility that is a skilled nursing facility to a portion of the facility that is not such a skilled nursing facility.


   Other rights. - Any other right established by the Secretary.


    The clause requiring privacy shall not be construed as requiring the provision of a private room.

    A resident's exercise of a right to refuse transfer shall not affect the resident's eligibility or entitlement to benefits under this title or to medical assistance under title XIX, Grants to States for Medical Assistance Programs.


B. Notice of rights and services.

    A skilled nursing facility must -

  1. (1)inform each resident, orally and in writing at the time of admission to the facility, of the resident's legal rights during the stay at the facility;

  2. (2)make available to each resident, upon reasonable request, a written statement of such rights, which is updated upon changes in such rights, including the State notice of the Medicaid rights and obligations of nursing facility residents and their spouses; and

  3. (3)inform each other resident, in writing before or at the time of admission and periodically during the resident's stay, of services available in the facility and of related charges for such services, including any charges for services not covered under this title or by the facility's basic per diem charge.


    The written description of legal rights under this subparagraph shall include a description of the protection of personal funds managed by the facility and a statement that a resident may file a complaint with a State survey and certification agency respecting resident abuse and neglect and misappropriation of resident property in the facility.


C. Rights of incompetent residents.

    In the case of a resident adjudged incompetent under the laws of a State, the rights of the resident under this title shall devolve upon, and, to the extent judged necessary by a court of competent jurisdiction, be exercised by, the person appointed under State law to act on the resident's behalf.


D. Use of psychopharmacologic drugs.

    Psychopharmacologic drugs, medication used to modify psychological functions and mental states, may be administered only on the orders of a physician and only as part of a plan, included in the written plan of care, designed to eliminate or modify the symptoms for which the drugs are prescribed and only if, at least annually, an independent, external consultant reviews the appropriateness of the drug plan of each resident receiving such drugs.


E. Information respecting advance directives.

    A skilled nursing facility must comply with section 1866(f) which requires, providers of services, Medicare+Choice organizations, or prepaid or eligible organizations -


    To maintain written policies and procedures with respect to all adult individuals receiving medical care by or through the provider organization.


     To provide written information to each individual concerning an individual’s rights under State law to make decisions concerning such medical care including the right to accept or refuse medical or surgical treatment, the right to formulate advance directives, and the policies of the provider respecting the implementation of such rights.


     To document in a prominent part of the individual’s current medical record whether or not the individual has executed an advanced directive;


   Not to condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive.


    To ensure compliance with requirement of State law respecting advance directives at facilities of the provider.


    And to provide for education for staff and the community on issues concerning advance directives.


F. Transfer and discharge rights.

    In general - A skilled nursing facility must permit each resident to remain in the facility and must not transfer or discharge the resident from the facility unless -

  1. (1)the transfer or discharge is necessary to meet the resident's welfare and the resident's welfare cannot be met in the facility;

  2. (2)the transfer or discharge is appropriate because the resident's health has improved sufficiently so the resident no longer needs the services provided by the facility;

  3. (3)the safety of individuals in the facility is endangered;

  4. (4)the health of individuals in the facility would otherwise be endangered;

  5. (5)the resident has failed, after reasonable and appropriate notice, to pay or to have paid under this title or title XIX, Grants to States for Medical Assistance Programs, on the resident's behalf for a stay at the facility; or

  6. (6)the facility ceases to operate.


    In each of the cases described in clauses (1) through (5), the basis for the transfer or discharge must be documented in the resident's clinical record. In the cases described in clauses (1) and (2), the documentation must be made by the resident's physician, and in the cases described in clauses (3) and (4) the documentation must be made by a physician.


G. Pre-transfer and pre-discharge notice.

     In general. - Before effecting a transfer or discharge of a resident, a skilled nursing facility must -

  1. (1)notify the resident and, if known, a family member of the resident or legal representative, of the transfer or discharge and the reasons therefor,

  2. (2)record the reasons in the resident's clinical record including any documentation required under Transfer and discharge rights above, and

  3. (3)include in the notice the items described in clause I. below.


H. Timing of notice.

    The notice in G. above to the resident and family member or legal representative must be made at least 30 days in advance of the resident's transfer or discharge except -

  1. (1)in a case described in items (3) or (4) of Transfer and Discharge rights above;

  2. (2)in a case described in item (2) of Transfer and Discharge rights above, where the resident's health improves sufficiently to allow a more immediate transfer or discharge;

  3. (3)in a case described in item (1) of Transfer and Discharge rights above, where a more immediate transfer or discharge is necessitated by the resident's urgent medical needs; or

  4. (4)in a case where a resident has not resided in the facility for 30 days.

    In the case of such exceptions, notice must be given as many days before the date of the transfer or discharge as is practicable


I. Items included in notice.

    Each item under the Pre-transfer or pre-discharge notice above must include-

  1. (1) notice of the resident's right to appeal the transfer or discharge under the State process; and

  2. (2)the name, mailing address, and telephone number of the State long-term care ombudsman.


J. Orientation.

    A skilled nursing facility must provide sufficient preparation and orientation to residents to ensure safe and orderly transfer or discharge from the facility.


K. Access and visitation rights.

    A skilled nursing facility must -

  1. (1)permit immediate access to any resident by any representative of the Secretary, by any representative of the State, by an ombudsman, or by the resident's individual physician;

  2. (2)permit immediate access to a resident, subject to the resident's right to deny or withdraw consent at any time, by immediate family or other relatives of the resident;

  3. (3)permit immediate access to a resident, subject to reasonable restrictions and the resident's right to deny or withdraw consent at any time, by others who are visiting with the consent of the resident;

  4. (4)permit reasonable access to a resident by any entity or individual that provides health, social, legal, or other services to the resident, subject to the resident's right to deny or withdraw consent at any time; and

  5. (5)permit representatives of the State ombudsman, with the permission of the resident or the resident's legal representative and consistent with State law, to examine a resident's clinical records.


L. Equal access to quality care.

    A skilled nursing facility must establish and maintain identical policies and practices regarding transfer, discharge, and covered services under this title for all individuals regardless of source of payment.


M. Admissions policy.

    Admissions. - With respect to admissions practices, a skilled nursing facility must -

  1. (1)not require individuals applying to reside or residing in the facility to waive their rights to benefits under this title or under a title XIX, Grants to States for Medical Assistance Programs,  State plan,

  2. (2)not require oral or written assurance that such individuals are not eligible for, or will not apply for, benefits under this title or such a State plan,

  3. (3)prominently display in the facility and provide to such individuals written information about how to apply for and use such benefits and how to receive refunds for previous payments covered by such benefits; and

  4. (4)not require a third party guarantee of payment to the facility as a condition of admission or to expedite admission, or continued stay in the facility


N. Construction.

    No preemption of stricter standards. - Admissions policy subparagraph above shall not be construed as preventing States or political subdivisions therein from prohibiting, under State or local law, the discrimination against individuals who are entitled to medical assistance under this title with respect to admissions practices of skilled nursing facilities.


    Contracts with legal representatives. - Admissions policy subparagraph above shall not be construed as preventing a facility from requiring an individual who has legal access to a resident's income or resources available to pay for care in the facility to sign a contract to provide payment from the resident's income or resources for such care without incurring personal financial liability.


O. Protection of resident funds.

    In general. - The skilled nursing facility -

  1. (1)may not require residents to deposit their personal funds with the facility, and

  2. (2)upon the written authorization of the resident, must hold, safeguard, and account for such personal funds under a system established and maintained by the facility in accordance with items O. through R.


P.  Management of personal funds.

    Upon written authorization of a resident under item (2) above, the facility must manage and account for the personal funds of the resident deposited with the facility as follows:


     Deposit. - The facility must deposit any amount of personal funds in excess of $100 with respect to a resident in an interest bearing account or accounts that is separate from any of the facility's operating accounts and credit all interest earned on such separate account to such account. With respect to any other personal funds, the facility must maintain such funds in a non-interest bearing account or petty cash fund.


    Accounting and records. - The facility must assure a full and complete separate accounting of each such resident's personal funds, maintain a written record of all financial transactions involving the personal funds of a resident deposited with the facility, and afford the resident or a legal representative of the resident reasonable access to such record.


    Conveyance upon death. - Upon the death of a resident with such an account, the facility must convey promptly the resident's personal funds and a final accounting of such funds to the individual administering the resident's estate.


Q. Assurance of financial security.

    The facility must purchase a surety bond, or otherwise provide assurance satisfactory to the Secretary, to assure the security of all personal funds of residents deposited with the facility.


R. Limitation on charges to personal funds.

    The facility may not impose a charge against the personal funds of a resident for any item or service for which payment is made under this title or title XIX, Grants to States for Medical Assistance Programs.


    4. REQUIREMENTS RELATING TO ADMINISTRATION AND OTHER MATTERS


A. Administration.

    In general. - A skilled nursing facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.  The administration must be consistent with requirements established under subsection (f)(5) of this act which reads: The Secretary shall establish criteria for assessing a skilled nursing facility's compliance with the requirement of this subsection with respect to -

  1. (a)its governing body and management,

  2. (b)agreements with hospitals regarding transfers of residents to and from the hospitals and to and from other skilled nursing facilities,

  3. (c)disaster preparedness,

  4. (d)direction of medical care by a physician,

  5. (e)laboratory and radiological services,

  6. (f)clinical records, and

  7. (g)resident and advocate participation.


    Skilled nursing facility administrator. - The administrator of a skilled nursing facility must meet standards established by the Secretary.


    Availability of survey, certification, and complaint investigation reports. - A skilled nursing facility must:

  1. (1)have reports to any surveys, certifications, and complaint investigations made respecting the facility during the 3 preceding years available for any individual to review upon request; and

  2. (2)post notice of the availability of such reports in areas of the facility that are prominent and accessible to the public.

    The facility shall not make available under item (1) above identifying information about complainants or residents.


B. Licensing and life safety code.

    Licensing. - A skilled nursing facility must be licensed under applicable State and local law.


    Life safety code. - A skilled nursing facility must meet such provisions of such edition, as specified by the Secretary in regulation, of the Life Safety Code of the National Fire Protection Association as are applicable to nursing homes; except that -


  1. (1)the Secretary may waive, for such periods as he deems appropriate, specific provisions of such Code which if rigidly applied would result in unreasonable hardship upon a facility, but only if such waiver would not adversely affect the health and safety of residents or personnel, and

  2. (2)the provisions of such Code shall not apply in any State if the Secretary finds that in such State there is in effect a fire and safety code, imposed by State law, which adequately protects residents of and personnel in skilled nursing facilities.


C. Sanitary and infection control and physical environment.

    A skilled nursing facility must -

  1. (1)establish and maintain an infection control program designed to provide a safe, sanitary, and comfortable environment in which residents reside and to help prevent the development and transmission of disease and infection, and

  2. (2)be designed, constructed, equipped, and maintained in a manner to protect the health and safety of residents, personnel, and the general public.


D. Miscellaneous.

    Compliance with federal, state, and local laws and professional standards. - A skilled nursing facility must operate and provide services in compliance with all applicable Federal, State, and local laws and regulations and with accepted professional standards and principles which apply to professionals providing services in such a facility.


    Other. - A skilled nursing facility must meet such other requirements relating to the health, safety, and well-being of residents or relating to the physical facilities thereof as the Secretary may find necessary.




Requirements for nursing facilities. Title 42, Chapter 7, §1396r.

www.law.cornell.edu/uscode/42/1396r.html



  END NOTE: The text of this act has been edited for clarity by rewording some bureaucratic terms, removal of superfluous wording that does not directly define nursing home requirements, and has been outlined in a simpler format for easier reading.  Applicable portions of other laws referred to in the act are inserted into the text in italics for clarity.  The limited editing and style changes have not altered the meaning or intent of the act.  Content is in the same order as the original document.


    If it is necessary to quote the actual wording of the act for legal or similar purposes, refer to the original version cited below by accessing it on the internet.  Some or all the material may be duplicated in other federal acts.




            5. STATE LICENSING LAWS & OPERATING REGULATIONS


  Each state has its own licensing laws and operating regulations defining how a nursing home must operate in that state.  Some are more complicated than others and often refer to or include other state regulations on such related matters as sanitation or safety into their requirements.  Most rely on federal regulations to set the majority of requirements and standards for what a nursing home is to be and how it is to operate.


    A licensed Administrator is required to manage long term care facilities and each state has their own process for training and licensing Administrators.


    State laws for nursing homes and nursing home administrators may be found at the web-link below.



   The University of Minnesota has an excellent website, NH Regulations Plus, which provides access to nursing home regulations by state and topic as well as to Federal regulations. The website can be accessed at:

http://www.hpm.umn.edu/nhregsplus/NHRegs_by_State/By%20State%20Main.html




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